Provider Demographics
NPI:1821115494
Name:THERRIEN, CAROL ANN (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:THERRIEN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CEDAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1068
Mailing Address - Country:US
Mailing Address - Phone:860-478-7702
Mailing Address - Fax:860-432-1335
Practice Address - Street 1:1750 ELLINGTON RD
Practice Address - Street 2:#3
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2746
Practice Address - Country:US
Practice Address - Phone:860-478-7702
Practice Address - Fax:860-432-1335
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist